Healthcare Provider Details

I. General information

NPI: 1013913557
Provider Name (Legal Business Name): KATHLEEN M BEWLEY-THOMAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 HARLEM AVE STE 1
TINLEY PARK IL
60477-1847
US

IV. Provider business mailing address

35318 EAGLE WAY
CHICAGO IL
60678-1353
US

V. Phone/Fax

Practice location:
  • Phone: 708-444-1512
  • Fax: 708-444-1878
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036108151
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: